Preferences for Over-the-Counter and Prescription Hearing Aid Processing Across Listening Environments.

PURPOSE: This study compared listener preferences for nonspeech environmental sounds processed by over-the-counter (OTC) hearing aids (HAs) and premium-level prescription (PRSC) HAs among young adults with typical hearing sensitivity. METHOD: Seventeen participants completed a within-subject, double-blind, round-robin comparison of recordings obtained from the processed outputs of four receiver-in-canal HAs: two U.S. Food and Drug Administration-approved OTC devices and two premium-level PRSC devices. Sound environments included conversational speech in complex noise, everyday nonspeech environmental sounds, and music. For each environment, each device recording was compared to every other device recording twice, yielding 12 comparisons per condition. Participants selected their preferred device and rated preference strength on a 101-point scale. Preference ratings were converted to tournament-style outcome scores and analyzed using repeated-measures ANOVAs with planned OTC versus PRSC contrasts. Multidimensional scaling (MDS) was used to examine acoustic-perceptual dimensions underlying preference judgments. RESULTS: Across listening environments, planned contrasts indicated higher overall preference for PRSC processing relative to OTC processing for speech in complex noise, nonspeech environmental sounds, and music. Device rankings varied by listening environment, with stronger separation between categories for speech in complex noise and nonspeech environmental sounds and more mixed preferences for music. MDS analyses indicated that perceptual dimensions were context dependent. Preferences for speech in complex noise were associated with spectral emphasis and with combined effects of output level, signal-to-noise ratio, and intermodulation distortion. Preferences for nonspeech environmental sounds and music were more strongly associated with overall level and additional spectral and distortion-related characteristics. CONCLUSIONS: Premium-level PRSC HAs were generally preferred in this sample, particularly for speech in complex noise and nonspeech environmental sounds; however, preferences varied across devices and listening environments. These findings highlight the multidimensional nature of sound quality perception and underscore the importance of considering listening context and individual priorities when counseling patients about OTC versus PRSC HA options. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.33249744.